Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewMonitoring the critically ill emergency department patient.
Many critically ill patients are remaining in the emergency department for extended periods of time, and delays in diagnosis and/or therapy may increase patient morbidity and mortality. All emergency physicians use monitoring modalities in critically ill patients to detect early cardiovascular compromise and impaired oxygen delivery before disastrous collapse occurs. The authors hope the discussion in this article regarding the monitoring of oxygenation, ventilation, arterial perfusion pressure, intravascular volume, markers of tissue hypoxia, and cardiac output will help the EP provide optimal care for this complicated patient population.
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Emergency physicians are regularly called on to care for critically poisoned patients. This article reviews the general approach and management of the critically poisoned patient. ⋯ Appropriate testing in the poisoned patient is reviewed. Complications of poisoning that may bring a rapid demise of the critically ill poisoned patient are highlighted and the management of those complications is discussed.
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Care for patients who have time-sensitive disease processes in the emergency department and critical care settings is optimized with rapid diagnosis and intervention. Recent advances in medical imaging have increased portability, decreased image acquisition time, improved data resolution, and increased use of noninvasive studies. This article discusses the use of portable imaging techniques such as bedside ultrasound and radiography as well as CT and CT angiography in the diagnosis and care of critically ill patients.
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewSevere sepsis and septic shock: improving outcomes in the emergency department.
With an increasing incidence of sepsis, increasing use of the emergency department by populations at risk, and an increase in time spent in the emergency department awaiting hospital admission, emergency medicine practitioners are offered a valuable opportunity to make a significant difference in the fight against sepsis. By administering appropriate antibiotics in a timely fashion, removing possible sources of infection, practicing early goal-directed hemodynamic optimization, using lung-protective ventilation strategies, and judiciously using corticosteroids and intensive insulin therapy, the goal of reducing mortality from sepsis can be achieved.
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Emerg. Med. Clin. North Am. · Aug 2008
ReviewNoninvasive positive pressure ventilation in the emergency department.
Noninvasive positive pressure ventilation (NPPV) is becoming more commonplace, both in the ICU and also in the Emergency Department. This article addresses the rationale and mechanism of action for NPPV. ⋯ NPPV should be considered for most patients who have respiratory distress who are being considered for intubation. After NPPV is initiated, very close monitoring and follow-up must be employed to identify those patients who are at risk for treatment failure.